USER 2016 .pdf

User Product Order Form
Enagic USA, Inc.
Headquarters
4115 Spencer St., Torrance, CA 90503
Phone: (310) 542-7700 / FAX: (310) 542-1700

PRINT CLEARLY

Toll Free: (866) 261-9500 / cc@enagic.com

Distributor ID # <Do NOT Fill In>

*Applicant Information
Legal Name (First, Middle Initial, Last) or Company Name

Driver's License #

Application Date:

State

Date of Birth
City

Phone Number

Fax Number

Cell Number

State

Zip Code

State

Zip Code

 SHIP

Mailing Address (must match W9)

Email Address

Alternate Shipping Address

City

*Sponsor Information
Sponsor Name

REGISTER THIS APPLICANT AS YOUR

[

]A

Under Sponsor
Phone Number

ID Number:

PAYMENT METHOD
Sales

 SINGLE PAYMENT
$

+
Unit Price

Product Retail Price

Tax

 ENAGIC PAYMENT

$

*Credit Card Information

 Visa

 6 months
+

Handling

Shipping

Total

<**Enagic Payment System Application Required**>

 3 months

$

= $

+

 10 months

+
Tax

+
Shipping

 16 months
=

$

Down

Total Down

***COMPLETION OF ALL OF THE FOLLOWING IS REQUIRED***
 Master Card
 Amex
 Discover

Card Number

CVV #

Card Holder Name (Please Print)

Card Holder Signature

Expiration Date

Alternate Pick-Up
Distributor Driver's License Number Print Name

Signature (Sponsor or Buyer)

Date

Sponsor Signature

Date

*Signature
Applicant Signature

Date

No Diner's Cards

 PICKUP

ITEM ORDERED

RETURN POLICY (EFFECTIVE August 2014)
1. A full refund minus shipping fees will be granted only if a product is returned and received by
Enagic USA, Inc. (“Company”)** unused within seven (7) days of receipt*.
2. A Restocking Fee (see below) will be charged when:
! A machine is returned used (eg. water is run through the machine) within seven
(7) days of receipt*.
! A new machine is returned after seven (7) days but before one (1) month of receipt*.
! FOR UKON PRODUCTS ONLY: the company must be notified (ukon@enagic.com)
within ten (10) business days of receipt*. No cancellations will be accepted after ten
(10) business days of receipt*.
3. A used machine returned after seven (7) days, but before one (1) month, of receipt will be
charged a Processing Fee (in lieu of a Restocking Fee) (see below).
Model

SD501

Restocking
Fee

$100

Processing
Fee

$380

SD501-U

SD501-P

DXII

JRII

ANESPA

R

SUPER 501

UKON DD

$200

$100

$100

$100

$100

$100

$100

$10/box

$660

$680

$310

$310

$320

$280

$700

$50

/Kangen8

(Processing fee for Member Anespa $240, Member Super 501 $410. Restocking Fee: $100)
4. A machine in any condition may NOT be returned for a refund after one (1) month following
receipt*.

! In the event of financing, the buyer understands and agrees to fulfill their monthly
payment obligations in totality if the product is outside of the Return Period.
5. Shipping fees will not be refunded. Installment charges (number of payments multiplied by $10)
are refunded on a prorated basis.
6. All machines must be securely packaged and returned to the Company**.
7. Proof of delivery is required for all returned products. It is the buyer’s responsibility to
return the product safely and securely.
* Receipt refers to the date of pickup or date of signed delivery of the product.
** Received at Company headquarters at 4115 Spencer St., Torrance, CA 90503.
Cautionary Notes for the SD501-U
Installation is borne by the client. Company does not provide any installations. We strongly
recommend hiring a carpenter and/or plumber to install your machine.
Drilling a hole in the countertop for the faucet and another hole in the wall for the control panel
is required. Company is not responsible for any installation or drilling repairs even if the product
is returned.
Company does not accept any machine changes after the SD 501-U has been installed.

I have read and fully understand all of the stipulations stated above.
Name: _________________________________________________________________

Applicant Signature: _____________________________________________________
Date: __________________________________________________________________
If a refund, chargeback, or cancellation is issued for an AMEX card, a 3.5% service fee will apply.

User%Product%Order%Form
Enagic%USA,%Inc.
Headquarters
4115-Spencer-St.,-Torrance,-CA-90503
Phone:-(310)-542A7700-/-FAX:-(310)-542A1700

%%%%%%%PRINT%CLEARLY

Toll-Free:-(866)-261A9500-/-cc@enagic.com

Distributor-ID-#-<Do#NOT#Fill#In>

*Applicant%Information
Legal-Name-(First,-Middle-Initial,-Last)-or-Company-Name

$

$$$$CA$$

9/1/80

9/1/80

State

Date-of-Birth

Mailing-Address-(must-match-W9)

City

Phone-Number

Fax-Number

TORRANCE

4115$SPENCER$STREET
(310)$54267700

Cell-Number

State

Zip-Code

State

Zip-Code

CA

90503

Email-Address

(310)$54267700

CC@ENAGIC.COM

Alternate-Shipping-Address

123$ENAGIC$AVE,$ $

$

$

$

$

City

TORRANCE$ $

CA$ $

90503

*Sponsor%Information
Sponsor-Name

CALL$CENTER

REGISTER THIS APPLICANT AS YOUR
!!Under!Sponsor

Phone-Number

ITEM%ORDERED

PAYMENT%METHOD

X-SINGLE-PAYMENT
$
1,280

SUNUS

Sales

+

DO$NOT$FILL$IN
+

Unit-Price
Product%Retail%Price

-

12345678

-ID-Number:-

(310)$53269000

[ 6 ]A

Tax

= $

1,280

Shipping

Total

-ENAGIC-PAYMENT------------<**Enagic-Payment-System-Application-Required**>
------- -3-months--------------- -6-months-------------- -10-months--------------- -16-months

$

1,280

$

+
Handling

+
Tax

+

=

Shipping

$

Down

Total%Down

*Credit%Card%Information%%!!!!!!!!!!!!!!***COMPLETION!OF!ALL!OF!THE!FOLLOWING!IS!REQUIRED***

X

----------------------- -Visa------------- -Master-Card------------- -Amex------------- -Discover---------Card-Number

-

1234656786901262345

1234

No#Diner's#Cards

09/09

Expiration-Date

CVV##

ere

*Signature$h

Card-Holder-Name-(Please-Print)

Card-Holder-Signature

JANE$DOE

Alternate%PickHUp

IF$SOMEONE$ELSE$IS$PICKING$UP$THE$MACHINE *Signature$here

Distributor-Driver's-License-Number Print-Name

Signature-(Sponsor-or-Buyer)

Date

Sponsor-Signature

Date

9/1/80

*Signature

ere
*Signature$h

Applicant-Signature

Date

9/1/80

ere

*Signature$h

9/1/80

X -SHIP--------------- -PICKUP

JON$DOE
D358998$ $

Driver's-License-#

Application-Date: